Efficiency frontier in health technologies assessments

Abstract

Cost-effectiveness (CE) thresholds have been under discussion regarding the need of a fixed threshold for the Brazilian reality, particularly for the public healthcare system. Often, the use of this type of threshold in other countries is mentioned, however, this varies significantly between countries and many are implicit. CE thresholds are based upon incremental CE results (ICER) and frequently include measures for quality adjusted life years (QALY), related to several limitations. Alternatives to CE thresholds have been proposed, such as the efficiency frontier, a method used by the German government to determine maximum reimbursement values for new technologies that are incorporated in its health system. For each therapeutic area, a graph is built with incremental benefit vs. costs of the technologies already incorporated. The options with higher cost-effectiveness are connected giving the efficiency frontier that are used for the assessment of new interventions. This article revises characteristics, limitations and alternatives of CE thresholds and proposes a discussion theme that goes beyond the suitability of setting a fixed threshold for Brazil.